Management of cardiovascular disease in chronic kidney disease: implications for managed care

Area of Science:

• Nephrology
• Public Health
• Health Economics

Background:

• Chronic kidney disease (CKD) is increasingly prevalent, often underdiagnosed, and represents a significant financial burden on healthcare systems, particularly Medicare.
• Cardiovascular disease (CVD) is the primary cause of mortality and hospitalization among individuals with CKD.
• Current strategies for CKD identification are cost-effective in high-risk groups, but optimal patient selection remains a challenge.

Purpose of the Study:

• To evaluate the cost-effectiveness of strategies for identifying and managing patients with chronic kidney disease.
• To assess the economic impact of specialist referral and individualized patient care in CKD management.
• To determine the most effective approaches for preventing adverse cardiovascular outcomes and mortality in CKD patients.

Main Methods:

• Analysis of Medicare spending related to CKD, hospitalizations, and drug therapies.
• Review of evidence on the cost-effectiveness of CKD screening in high-risk populations (e.g., patients with diabetes).
• Evaluation of the cost-effectiveness of specialist referral based on estimated glomerular filtration rate (eGFR) thresholds and patient demographics (age, comorbidities).

Main Results:

• CKD care incurs substantial costs, mainly from hospitalizations and medications.
• Early specialist referral (eGFR ~60 mL/min/1.73 m2) is cost-effective, particularly for older patients and those with diabetes.
• Individualized care addressing comorbidities like hypertension, diabetes, albuminuria, and dyslipidemia is cost-effective or cost-saving, reducing CVD events and mortality.

Conclusions:

• Improving CKD identification and management, especially through specialist care and individualized treatment plans, offers significant cost savings and improved patient outcomes.
• Targeted interventions for high-risk CKD patients, including those with diabetes, are crucial for economic and clinical benefits.
• Ensuring access to and adherence to specialist care and therapies is a vital, cost-effective strategy for mitigating the burden of CKD and associated CVD.